IntroductIon.Effective strategies for prophylaxis of venous thromboembolism (VTE) are widely available, but remain underused, especially in Brazil. objectIve. The objective of this study was to assess the effect of implementing a guideline for VTE prophylaxis for surgical patients on the behavior of the health care staff regarding prophylaxis for patients submitted to orthopedic or abdominal surgery. Methods. This was a retrospective pre-intervention/post-intervention study. The charts of 150 patients before (BGI) and 150 ones after guideline implementation (AGI) were selected at random from all patients over the age of 40 admitted for major abdominal or orthopedic surgery. Data registered: demographic data, reference to VTE risk factors in chart, VTE prophylaxis prescription, VTE diagnosis during hospitalization. results. There was no difference between BGI and AGI in terms of demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of BGI versus AGI prophylaxis before surgery was: pharmacological prophylaxis (PP), 6% versus 9%; graduated compression stockings (GCS), 4% versus 3%; intermittent pneumatic compression (IPC), 2% versus 3%. After surgery: PP, 53% versus 53%; GCS, 23% versus 40% (p < 0.05); IPC, 26% versus 32%. Including all patients, prophylaxis was prescribed for 60.5% of patients BGI and 66.5% AGI, but it was considered adequate for 34% of patients BGI and 32% AGI. conclusIon. Adoption of the guideline, despite the greater concern with prophylaxis, as expressed by higher rates of prescription of GCS, provided only minimal quality improvements, indicating that other active and continuous interventions are needed to increase compliance.
Lopap, found in the bristles of Lonomia obliqua caterpillar, is the first exogenous prothrombin activator that shows serine protease-like activity, independent of prothrombinase components and unique lipocalin reported to interfere with hemostasis mechanisms. To assess the action of an exogenous prothrombin activator reversing the anticoagulant and antihemostatic effect induced by low molecular weight heparin (LMWH), male New Zealand rabbits (N = 20, weighing 3.8-4.0 kg) allocated to 4 groups were anticoagulated with 1800 IU/kg LMWH (iv) over 2 min, followed by iv administration of saline or recombinant Lopap (rLopap) at 1 µg/kg (LG1) or 10 µg/kg (LG10), 10 min after the injection of LMWH, in a blind manner. Control animals were treated only with saline. The action of rLopap was assessed in terms of activated partial thromboplastin time (aPTT), prothrombin fragment F1+2, fibrinogen, and ear puncture bleeding time (BT) at 5, 10, 15, 17, 20, 30, 40, 60, and 90 min after initiation of LMWH infusion. LG10 animals showed a decrease of aPTT in more than 50% and BT near to normal baseline. The level of prothrombin fragment F1+2 measured by ELISA had a 6-fold increase with rLopap treatment (10 µg/kg) and was inversely proportional to BT in LMWH-treated animals. Thus, Lopap, obtained in recombinant form using E. coli expression system, was useful in antagonizing the effect of LMWH through direct prothrombin activation, which can be a possible strategy for the reversal of bleeding and anticoagulant events.
BackgroundHemolin proteins are cell adhesion molecules from lepidopterans involved in a wide range of cell interactions concerning their adhesion properties. However, hemolin’s roles in cell proliferation and wound healing are not fully elucidated. It has been recently reported that rLosac, a recombinant hemolin from the caterpillar Lonomia obliqua, presents antiapoptotic activity and is capable of improving in vitro wound healing. Therefore, this study aimed to explore rLosac’s in vivo effects using a skin wound healing model in rats.MethodsCircular full-thickness wounds in the rat dorsum skin were treated either with rLosac, or with saline (control), allowing healing by keeping the wounds occluded and moist. During the wound healing, the following tissue regeneration parameters were evaluated: wound closure and collagen content. Furthermore, tissue sections were subjected to histological and immunohistochemical analyses.ResultsThe rLosac treatment has demonstrated its capacity to improve wound healing, as reflected in findings of a larger number of activated fibroblasts, proliferation of epithelial cells, increase of collagen type 1, and decrease of inflammatory infiltrate.ConclusionThe findings have indicated the rLosac protein as a very promising molecule for the development of new wound-healing formulations.
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